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Case Review #3
The ClavicleA long, curved bone that sits nearly horizontalForms the anterior portion of the shoulder girdleBony connection between the upper limb and thoraxLateral motion of the arms
Functions of the ClavicleRigid support for scapula and armProtection for NV bundle and lung apexMotion and stabilityTransmission of physical impactsMuscle attachments
Clavicle FracturesMost common acute shoulder injuryMost common fracture in children and young adultsEasily fractured
Classification Systems: Allman and Neer
Group 2 Type 1 Intact ligamentsGroup 2 Type 2Conoid and Trapezoid ligaments are intactProximal segment is displacedGroup 2 Type 2BConoid ligament is rupturedTrapezoid ligament remains intactProximal segment is displaced
How do clavicle fractures happen?Direct fall onto shoulderContact sportsFOOSH in a small % of casesMVAChild birth
When the clavicle fractures.....
Elevation of the medial fragmentDrooping of the arm
Unable to sustain the weight of the arm
The Patient.....An 8 yr old maleFell into a ditch
May 1, 2013Mild displacement of the distal 1/3 right clavicle fracture
June 13, 2013Follow up visit to the Ortho ClinicHealing fracture of the lateral 1/3 with mild deformity & displacement
PACS Image 478 0856.001K
Patient Care Concerns....Patient may be on a stretcher.....Pain, bleeding, swelling, bruising, tenting.....Immobilized.....Scared.....Vital Signs.....ABCs
Treatment Plans and Follow up.......
Views of the Clavicle:APAP Axial (15-30 degree cephalic)
If Pneumothorax or Hemothorax is suspected......
Non-operative Treatments.....Immobilization (sling, figure 8 bracing).....
Non-operative Treatments contd....Physiotherapy
Pendulum ExercisesBall Grip One should avoid:Arm raisingLifting more than 5 lbs
Use ice to reduce pain, swelling and inflammationGood body mechanicsimmobilization
Non-operative Treatments cont....Follow up visits with doctor/orthopedic surgeonSubsequent imaging to check for healing progressPain management
Surgery may be warranted if......Comminuted fractures Clavicle foreshorteningOpen fractureNeurovascular involvementNon-union of boneInterference with normal functioning
Plate FixationIntramedullary Fixation
Some interesting facts.......
Did you know.....The clavicle is reliable in determining gender differences........
In the male:Longer and thickerAcromial end is slightly higher than the sternal end
In the female:Thinner an shorterSmoother and lighterAcromial end is slightly below level of sternal end
The clavicle can also be useful for.....Bone Age Assessment
Distal Clavicular OsteolysisOveruse injuryConsistent with stress fracturesCommon with weightliftersTrauma can precipitate developmentJoint space enlargement
Thoracic Outlet SyndromeCommon causes:TraumaCallus formationRepetitive injuryInjury from years agoAnatomical defects
Blood vessels and nerves become compressed causing pain and numbness
Medial clavicle fractures can be very dangerous....A 19 yr old male on a motorbike involved in a head on collision
Chest x-ray revealed a massive left Pneumo-hemothorax and mediastinal shift
Fracture of the medial 1/3 clavicle with significant displacement
Clavicle fracture. (2013, July 16). Retrieved from http://www.patient.co.uk/doctor/Fractured- Clavicle.htm Clavicle fracture classification. (2013, July 16). Retrieved from http://eorif.com/clavicle-fracture-classification Daruwalla, Z., Courtis, P., Fitzpatrick, C., Fitzpatrick, D., & Mullett, H. (2010). An application of principle component analysis to the clavicle and clavicle fixation devices. Retrieved from http://openi.nlm.nih.gov/detailedresult.php?img=3003245_1749-799X-5-21-11&req=4 Distal clavicular osteolysis. (2010). Retrieved from http://www.wosm.com/index.php/orthopaedic-services-/shoulder/141-distal-clavicular-osteolysis Faisham, W. I., Mohammad, P., Juhara, H., Munirah, N. M., Shansulkamaruljan, H., & Ziyadi, G. M. (2011, June). Clavicle fracture and subclavian vessels disruption with massive haemothorax mimic intrathoracic injury. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3216210/ Rubino, MD, L. J. (2012, March 7). Clavicle fractures. Retrieved from http://emedicine.medscape.com/article/1260953-overview Thoracic outlet syndrome. (2013, July 16). Retrieved from http://www.mayoclinic.com/health/thoracic-outlet-syndrome/DS00800/DSECTION=causes